Whole organ pancreas transplantation is intended for patients with type 1 diabetes with secondary complications. The majority of patients will have kidney failure due to diabetic nephropathy and will either undergo a simultaneous kidney and pancreas transplant or will have received a prior kidney transplant with stable function. Patients with advanced heart disease may not be candidates for pancreas transplantation.
A small minority of patients may qualify for pancreas transplantation alone or islet transplantation if they have life-threatening episodes of hypoglycemic unawareness or extremely unstable diabetes. Each patient is evaluated for pancreas or islet transplantation on an individual basis.
Simultaneous Pancreas/Kidney (SPK) Transplantation Candidate Criteria
To be considered for Simultaneous Pancreas/Kidney (SPK) Transplant Evaluation, individuals must meet the following criteria:
1. Type I Insulin-Dependent Diabetes Mellitus
- confirmed by c-peptide level <0.3 ng/ml
- less than 45 years of age - Individuals over age 45 considered on an individual basis after approval by the Director of Pancreas Transplant Program
2. Problems with conventional therapies to manage glucose control (ADA Guidelines, 1998)
- history of metabolic complications requiring medical care
- incapacitating clinical and/or emotional problems with exogenous insulin therapy
- life-threatening hypoglycemic unawareness
3. Irreversible loss of renal function
- currently requiring dialytic therapy
- renal insufficiency demonstrated by:
a) creatinine clearance of 25 ml./min. or less
b) elevated serum creatinine, where the renal function is inadequate to support the patient in the face of immunosuppression with either cyclosporine or tacrolimus
Note: Individuals with renal insufficiency may be evaluated before initiating dialysis or placement of dialysis access. Since the waiting time for a cadaver SPK transplant is usually more than one year, and can exceed two years, evaluation prior to the initiation of dialytic therapy is encouraged.
4. Absence of recent malignancy except locally excised skin cancers
5. Absence of active addiction to drugs and/or alcohol*
6. Weight Criteria
- Candidates in excess of 13 percent of ideal body weight may be considered for a pancreas transplant on an individual basis.
7. Ability to understand proposed therapeutic intervention and ability to appropriately participate in care.
* Patients actively abusing drugs and/or alcohol are not considered candidates for evaluation based on inability to participate and comply with the therapeutic regimen.
For more information on the kidney or kidney/pancreas transplant program at Barnes-Jewish Hospital, call [Dynamic_Phone_Number].